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背景:在全球,耐药结核病越来越严重,可能会造成对暴露于耐药结核病患者的儿童的诊断和治疗成为难题。在法国,对暴露的儿童给予3个月的异烟肼+利福平的系统化预防性治疗。目的:描述法国5年来(2004—2008年)与耐药结核病患者密切接触的2岁以下婴幼儿的特征和对其的治疗管理。方法:通过给法国儿科协会的儿科传染病分会和儿科肺病分会的所有成员发放问卷,回顾性地确定符合条件的婴幼儿,并纳入本研究。结果:纳入了与成年耐药结核病患者密切接触的婴幼儿10例:6例为耐药结核病患儿(平均年龄4.6个月),1例为结核分枝杆菌感染,3例为暴露未感染(平均年龄3.1个月)。这些儿童主要接触的是多耐药或耐多药结核病患者。对结核病患儿给予适当治疗的开始时间为39d,对结核分枝杆菌感染或暴露未感染婴幼儿给予适当治疗的开始时间为58d。由于未能及时调整预防性治疗方案,1名儿童从结核分枝杆菌感染发展成为结核病。对婴幼儿的治疗是多样、个体化的。短期随访显示,纳入本研究的所有婴幼儿均被完全治愈。结论:对与成年耐药结核病患者密切接触的婴幼儿的管理,要求快速明确传染源的耐药情况。应采用分子学诊断技术,以及时开始适当的治疗。
Background: Globally, drug-resistant TB is becoming more and more serious and may cause problems in the diagnosis and treatment of children exposed to drug-resistant TB. In France, exposed children were given systemic prophylactic treatment of isoniazid plus rifampin for 3 months. Objectives: To characterize and manage the treatment of infants under 2 in France who have been in close contact with drug-resistant TB patients for 5 years (2004-2008). METHODS: Questionnaires were circulated to all members of the Pediatric Infectious Diseases and Pediatric Pulmonology Lions of the Pediatric Society of France to retrospectively identify eligible infants and young children for inclusion in the study. Results: Ten infants and young children were included who were in close contact with adult drug resistant TB patients: 6 were resistant to tuberculosis (mean age, 4.6 months), 1 was Mycobacterium tuberculosis infection and 3 was unexposed Average age of 3.1 months). These children are mainly exposed to multi-drug resistant or multi-drug resistant TB patients. The onset of appropriate treatment for children with tuberculosis was 39 days and the onset of appropriate treatment for M. tuberculosis infection or exposure of uninfected infants was 58 days. One child developed TB disease from M. tuberculosis due to a failure to promptly adjust for preventive treatment. The treatment of infants and young children is diverse and individualized. Short-term follow-up showed that all infants and young children enrolled in this study were completely cured. Conclusion: The management of infants and toddlers in close contact with adults with MDR-TB requires rapid and clear identification of the source of resistance. Molecular diagnostic techniques should be used to start the appropriate treatment promptly.